Der Schmerz
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Different therapeutic modalities are available for the treatment of rheumatic pain. The most important one, besides physiotherapy, is medication with analgesics and adjuvant drugs. Analgesics are given orally and by a stepwise approach in keeping with the principles of cancer pain therapy. ⋯ Patients often suffer from constipation, nausea and vomiting, but these side-effects can be treated with laxatives and antiemetic drugs. There is no reason to differentiate between opioid medication in a cancer patient with pain and in a patient with "non-malignant" rheumatic pain. Centrally acting muscle relaxants may be helpful as adjuvant medication in patients with myalgia for example, and tricyclic antidepressants can also be beneficial, especially in neuropathic pain and for patients with psychiatric distress associated with pain.
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Vitamins of the B group have long been used to treat neuropathies of different origins and the accompanying pain. A combination of the vitamins B(1), B(6), and B(12) prevents the slowing of impulse conduction produced by tetanic stimulation in diabetic mice. In patients suffering from diabetic neuropathy, B vitamins alleviate pain in the upper extremities. ⋯ It has recently also been reported that a combination of the vitamins B1, B6, and B12 has analgesic properties in non-neuropathic conditions. In animal experiments, B vitamins diminish nociceptive responses in spinal and thalamic neurones and potentiate the antinociceptive effect of analgesic agents. Similarly, B vitamins potentiate the therapeutic effect of diclofenac in patients suffering from acute low back pain.